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Actinic Keratosis – Causes, Symptoms and Treatment

Actinic keratosis is a rough, scaly skin lesion caused by long-term UV exposure and is considered a precancerous condition. Early treatment helps prevent progression.

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Things worth knowing about "Actinic Keratosis"

Actinic keratosis is a rough, scaly skin lesion caused by long-term UV exposure and is considered a precancerous condition. Early treatment helps prevent progression.

What is Actinic Keratosis?

Actinic keratosis (also known as solar keratosis) is a common skin condition caused by chronic exposure to ultraviolet (UV) radiation. It is classified as a precancerous lesion, meaning it has the potential to develop into squamous cell carcinoma of the skin if left untreated. The condition results from cumulative UV-induced DNA damage to the keratinocytes in the outermost layer of the skin (epidermis). Actinic keratosis is one of the most frequently diagnosed dermatological conditions, particularly in fair-skinned individuals and older adults with a history of significant sun exposure.

Causes and Risk Factors

The primary cause of actinic keratosis is prolonged and repeated exposure to UV radiation, especially UV-B rays, which cause damage to the DNA of skin cells. Key risk factors include:

Fair skin tone (Fitzpatrick skin types I and II)
Cumulative sun exposure through outdoor work or leisure activities
Use of tanning beds
Older age
Immunosuppression (e.g., following organ transplantation or in HIV patients)
Living in sun-intense regions or at high altitudes

Symptoms and Appearance

Actinic keratoses typically appear on sun-exposed areas of the body, including the face, scalp, ears, neck, chest, and back of the hands. Common characteristics include:

Rough, dry, scaly, or crusted patches of skin
Reddish, brownish, or skin-colored flat lesions
Occasional itching, burning, or tenderness
Wart-like or hardened surface in more advanced lesions
Size typically ranging from a few millimeters to about 2 centimeters

In some cases, lesions are more easily felt than seen. The presence of one actinic keratosis often indicates that additional lesions may be present nearby.

Diagnosis

Diagnosis is typically made by a dermatologist through a clinical skin examination. The following diagnostic methods may be used:

Visual inspection and palpation: Assessment of color, texture, and extent of the lesion.
Dermoscopy: Magnified examination of the skin surface using a dermatoscope to identify characteristic patterns.
Reflectance confocal microscopy: A non-invasive imaging technique providing detailed tissue visualization.
Histological examination: In uncertain cases, a skin biopsy is taken and examined under a microscope to rule out malignant transformation.

Treatment

Because actinic keratoses carry a risk of progression to squamous cell carcinoma, treatment is generally recommended. The choice of therapy depends on the number, location, and extent of the lesions, as well as the overall health of the patient.

Local Treatment Procedures

Cryotherapy: Freezing of affected areas using liquid nitrogen; fast and effective for individual lesions.
Curettage: Mechanical removal of the altered skin tissue.
Laser treatment: Ablation using CO2 or erbium laser.

Topical Drug Therapy

5-Fluorouracil (5-FU): A cytotoxic cream that destroys abnormal skin cells.
Imiquimod: An immune response modifier that activates the local immune system against abnormal cells.
Diclofenac gel: An anti-inflammatory gel suitable for mild cases.
Ingenol mebutate: A plant-derived gel that destroys tumor cells (withdrawn from some markets).

Photodynamic Therapy (PDT)

Photodynamic therapy involves applying a light-sensitive substance (photosensitizer) to the skin, which is then activated by light of a specific wavelength. The resulting reactive oxygen species selectively destroy the abnormal cells. This method is particularly well-suited for widespread or field-area lesions.

Prevention

The most effective prevention strategy is consistent sun protection:

Daily use of broad-spectrum sunscreen with SPF 30 or higher
Wearing protective clothing, wide-brimmed hats, and sunglasses
Avoiding peak sun hours between 11 a.m. and 3 p.m.
Avoiding tanning beds
Regular skin check-ups with a dermatologist

References

Deutsche Dermatologische Gesellschaft (DDG): S3 Guideline on Actinic Keratosis and Cutaneous Squamous Cell Carcinoma (2022).
Stockfleth E. et al. - Actinic keratosis: an update on current therapies. Journal of the European Academy of Dermatology and Venereology, 2021.
World Health Organization (WHO): Ultraviolet radiation and the INTERSUN Programme. Available at: https://www.who.int/uv/en/

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